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Medicare Advantage Plans in Texas

If you wish your Medicare insurance offered more benefits, Medicare Advantage plans in Texas may be a good fit. Otherwise known as Medicare Part C, this insurance plan combines the benefits of Medicare Part A and Part B along with additional benefits. A Medicare Advantage plan can be a good option for beneficiaries who want better coverage.

What Is Medicare Advantage?

Medicare Advantage plans in Texas offer the same benefits as Medicare Part A and Part B. They may also offer any of the following:

  • Wellness Benefits
  • Dental Benefits
  • Vision Benefits
  • Prescription Benefits

You can choose any Part C policy that offers the type of coverage that you need. For example, if you don’t take prescription medication, you may not care as much about a policy with prescription coverage. But if you wear glasses or see the doctor for well-checks, you may want those benefits on your plan. Each insurance company offers something different, so make sure to shop around to find the plan that is right for you.

The Type of Insurance

You buy your Medicare Advantage insurance plan from a private insurance company. You have many options, including the following:

  • HMO — With an HMO plan, you choose one doctor who becomes your primary doctor. You see this person first for everything. If you need to see a specialist, your primary doctor must refer you first. If you see a specialist without a referral, the insurance company could deny your claim.
  • PPO — With a Preferred Provider Organization plan, you can choose any doctor in the network. If you see a doctor outside of the network, you may still receive benefits; they are typically at a lower percentage, though. You don’t need a referral to see a specialist with the PPO program.
  • PFFS — The Private Fee-for-Service Plan is a private plan offered by insurance companies. Medicare sponsors the plan, but the insurance company determines the prices it pays for each medical service. The provider you see must agree to the PFFS prices before you can be seen.
  • Special Needs Plans — SNPs offer special insurance for chronically ill, disabled, or very low-income beneficiaries. SNPs coordinate special care given the beneficiary’s situation, and only certain beneficiaries qualify for this program.

Paying for Medicare Advantage Plans in Texas

Each of the Medicare Advantage plans in Texas has different fees. In general, you can expect to pay the following:

  • Premiums — Each insurance company charges a different monthly premium for Medicare Advantage. You pay this fee every month in exchange for the insurance policy even if you don’t use the insurance that month.
  • Medicare Part B Premiums — You may also pay some or all of your Medicare Part B premium. Each insurance plan is different, as some plans cover the premium for you and others require you to pay the full amount.
  • Deductibles — Some insurance plans have a deductible, which is an amount that you must pay before the insurance will cover any portion of your medical bills.
  • Co-Pay — You may owe a flat fee every time you go to the doctor. You may pay the copay alone or in addition to co-insurance.
  • Co-Insurance — This is a percentage of the cost of your medical services. If you have an 80/20 plan, the insurance company covers 80 percent of the medical services and you then owe 20 percent of it.

Because each insurance plan is different, it’s important to shop around and find the plan that’s right for you. Think of the amount of the premiums, the deductible, and what type of coverage you need before deciding.

Prescription Drug Coverage on Medicare Advantage Plans in Texas

Unlike Medicare Part A and Part B, Medicare Advantage plans often include prescription drug coverage. This wraps all of your insurance into one premium. Rather than paying a premium for Medicare Part B and Part D (prescription coverage), you can have one premium and one policy to handle.

If you need greater benefits than what Medicare Part A and Part B offer, consider Medicare Advantage plans in Texas. You have many options to choose from as long as you find an insurance company within your service area. You can sign up for a Part C plan as soon as you are eligible for Medicare. If you don’t enroll right away, you can enroll in or change plans during Open Enrollment each year.

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